Radiation and Radiological Events John Gough, MS, CHP, CMLSO Radiation Safety Officer Swedish Medical Center Objectives • Radiation Basics • Common Radiation Sources • Radiation Dose Limits and Emergency recommendations • Radiological Events as they relate to possible future events • Q&A Introduction • A Radiological Event involves the accidental or purposeful release of radiation or radioactive materials into the public or environment • This can create fear, injury and death and lead to severe disruption. – Fear is due to the public’s general fear of radiation. – Injury and death may be the result of the explosive and could result from sufficient radiation exposure. – Disruption results from of panic and the cleanup of the radioactive material and any consequent avoidance of the radioactive location after clean up. History Roentgen’s Discovers X-rays November 8, 1895 Becquerel and Curie’s Discover Radioactivity Pitchblende (Uranium ore) August 1, 1903 Radiation as seen by public Radiation Reality • • • • • • • • Been studied for over 100 years Is naturally occurring Characterized very well Risk are well known for high levels Have a lot of human data Weak carcinogen Weak mutagen Saves thousands of lives Common Uses of Radiation / Radioactivity • Medical – (Nuclear Medicine, Radiation Therapy, X-ray) • Industrial Radiography – (Structural Testing) • Sterilization – (Blood Sterilization) • Consumer products – (Smoke Detectors, Tritium Luminescent Materials) Radiation Physics Radiation • The most basic definition of radiation is the transfer of energy from on location to another. For example a car hitting a tree. In very simple terms it is the transfer of energy from one location to another. • Radiation is defined as energy in transit as either electromagnetic wave or energetic particles. Ionizing vs. Non-Ionizing • Non-Ionizing Radiation – Transfers energy by heat conduction – No chemical effects • Ionizing Radiation – Has the ability to induce chemical changes – Transfers very little energy relative to biological damage Types and Properties of Radiation Units Roentgen (R) Rad or Gray Rem or Sieverts Radioactivity (Bq) – Attributed to material and describes the number of emissions occurring in a given time Curie (Ci) Radiation Production • Radioactivity – Continuously emitting radiation (no off switch) – e.g. Tc-99m, Uranium • Machine Sources – Only emits when on – e.g. X-ray Machine Half-Life • A measure of the amount of time for ½ of the activity to disappear • Given enough time all radioactive materials will decay to background levels. Some radioactive isotopes and their half-life Isotope Fluorine-18 Technetium-99m Iodine-131 Iridium-192 Cesium-137 Radium-226 Uranium-238 Half-Life 110 minutes 6 hours 8 days 74 days 30 years 1600 years 4.5 billion years Radioactive 10987654321half-lives half-lives half-life Material Radiation Sources Sources of Background Radiation Radiation Doses – Medical Procedures Cardiac Stress Test – 730 mrem Chest x-ray PA – 2 mrem CT – Chest / Ab / Pelvis – 1800 mrem Lumbar Spine Series – 180 mrem I-131 Thyroid CA Therapy – 22,000 mrem Bitewing Dental X-ray – 0.4 mrem http://www.doseinfo-radar.com/ from the RAdiation Dose Assessment Resource Typical Radiation Doses Astronaut in space for 1 month, 15,000 mrem Average US Smoker 5300 mrem to the lungs 630 mrem whole body dose TSA X-ray Screening Device 0.1 mrem or less per scan Round Trip – NY to LA 10 mrem Living in Denver, CO vs. Seattle WA for 1 year – 25 mrem (additional cosmic radiation exposure due to altitute) Biological Effects Acute effects generally do not occur for radiation dose below 25 rem (25,000 mrem). They also do not appear when doses are delivered over a prolonged period of time. Industrial Radiography accident due to handling of a radiography source - 2001 Fluoroscopy “burn” early 1990 Hair loss as a result of a CT Brain Perfusion Scan at Cedar Sinai, 2008-2009. Acute Radiation Effects (Total Body Exposures) Dose (rad) Whole Body Effect Time to Onset 25-50 Blood Count Changes Days to 1 Month 150 Physiological Effects Hours to Days 350 LD 50/60 (no medical care) 2 Months 600 LD 50/60 (medical care) 2+ Months 850 – 900 100% fatal Weeks 1000 GI Syndrome Days 2000 CNS Effects Hours Chronic / Delayed Effects • The Risk of cancer from exposure to radiation is well documented for exposure to radiation doses above 10 rad (single exposure, not exposure over time). • The risk from single exposure below 10 rad or chronic low level exposures (e.g. occupational doses) are postulated based on statistical analysis. There are no epidemiological studies that confirm or deny the effects of single doses below 10 rad or from chronic low level exposure where the only radiation is involved. • Risk data is primarily derived from studies of the survivors of Hiroshima and Nagasaki. • Delayed / Chronic effect typically show after a latency period that can be from 5 years to more than 50 years. Cancer Risk • Cancer risk is derived from Japanese bomb survivor data • Background Cancer risk in the US is approximately 42%, fatal cancer risk, 23% • 0.0005 risk per rem = 1 in 2,000 chance of fatal cancer per rem of exposure (general population) • 1 in 1,000,000 risk of fatal cancer from a Chest X-ray Biological Effects of Ionizing Radiation (BEIR) VII Report (2006) Activities with a 1 in 1,000,000 risk of fatality Driving a car 80 miles. Driving a motorcycle 2.6 miles Riding a bicycle 26 miles Eating 43 TBSP of peanut butter. About 1 jar. Risks from Everyday Activities Activity Smoking 10 cigarettes/day Influenza Playing Soccer Hit by Lightning Fatality/year 1 in 200 1 in 6,000 1 in 100,000 1 in 10,000,000 Fishing and Logging Coal Mining Agriculture Firefighter Police Officer Construction Industry 1 in 1,000 1 in 3,600 1 in 4,000 1 in 6,000 1 in 6,000 1 in 10,000 Dose Limits and Exposure Recommendations Radiation Dose Limits Part of Body Annual Limit (mrem) Whole Body (TEDE) 5,000 Organ or Extremity 50,000 Lens of the Eye 15,000 Dose to Fetus (Radiation Worker) 500 General Public (individual) 100 *WAC 246-221-010 and 055, 10 CFR Part 20 Federal Protective Action Guide Dose Limit (Whole Body) Emergency Action Dose Guidelines 5 rem All Activities allowed (maximum whole body dose limit for occupational workers) 10 rem Protection of major property only 25 rem Lifesaving or protection of large populations >25 rem Lifesaving or protection of large populations. Only by volunteers who understand the risks. EPA Protective Action Guides - 1992 Federal Protective Action Guide - Revision Dose Limit (Whole Body) Emergency Action Dose Guidelines 50 rem Lifesaving or protection of large populations – By Volunteers >50 rem Lifesaving or protection of large populations. Only by volunteers who understand the risks. ICRP (1991), NCRP Report No. 116 and NCRP Report No. 138, DHS (2007) Decontamination Limits • Standard Limits USNRC and NCRP (Unrestricted Access to Property) (Has also applied to personnel contamination) – 2000 dpm / 100 cm2 (beta/gamma) – 1 nCi – 200 dpm / 100 cm2 (more hazardous beta/gamma) – 0.1 nCi – 20 dpm / 100 cm2 (source material) – 0.01 nCi – 2 mR/hr (for fixed sources, no removable contamination) Activity Magnitudes Use or Where typically found Activity 1 pCi (10-12 Ci) Quantities found naturally in the environment 1 nCi Typical Decontamination level 1 uCi Typical laboratory research quantity 1 mCi Diagnostic administration of radioactivity for nuclear medicine studies 1 Ci 1000 Ci Therapeutic administration of radiation (cancer treatment) Sterilization (Blood irradiators) Radiological Events International Atomic Energy Agency (IAEA) Supplementary Radiation Symbol approved in 2007. Radiological Accident Statistics (1945-2007) • About 50 (documented) accidents in the US involving radioactive material/radiation sources. – 400+ worldwide • 33 (documented) fatalities in the US (over ½ from medical accidents) – 100+ worldwide • 230+ (documented) radiation injuries in the US. – 3000+ worldwide • 28 documented criminal acts involving the use of radioactive material/radiation to cause injury/death (6 in the US, remainder in USSR/Russia, Taiwan and London) Types of Radiological Events • Atomic/Nuclear Weapon • Accidental Release of Radioactive Material – Reactor Accident – Transportation Accident – Loss Source • Radiological Dispersal/Exposure Device – Explosive – Non-Explosive (~12 documented criminal cases worldwide) NY Times, April 23, 2010 Scrap Metal Radiation Raises Concerns in India • April 2010 – Mayapuri, India • Co-60 Gamma Cell Irradiator (unused since 1985 from New Delhi University) sold as scrap metal at auction in Feb 2010. • Dealer cut the Co-60 cell into 11 pieces. • 8 injured, 1 death Nuclear Device Hiroshima, Japan • 15 kilo-ton U-235 (80% enriched) bomb • Population 385,000 • Immediate damage radius ~ 1 mile • 80,000 (est.) fatalities (most from blast injuries (about 80%) – with 70% of the remaining 20% dying within the first two months. Photograph from HMS Vengeance November 1945 Hypothetical Improvised Nuclear Device • Based on “Planning Guidance for Response to a Nuclear Detonation” Homeland Security Council - 2009 – Hypothetical planning is based on a 10 kT device (Same destructive magnitude as devices used in Hiroshima and Nagasaki) – Blast Damage Radius of 3 miles and fallout radius of 20 miles – Casualty statistics are not specifically determined in the report but values can be determined from a comparison of the effects to populations at Hiroshima and Nagasaki vs. population of the affected area. Projected Impact of a 10 Kiloton Improvised Nuclear Device Depiction of fatalities in Seattle from a 10 KT IND. Ground Zero is the Coleman Dock. Based on Presidential Directive #8. • • • • • • ~50,000 dead 3-5 Hospitals affected (Swedish FH, CH and Harborview, Group Health Central and Virginia Mason) Infrastructure damage out to 1 mile 450,000 evacuated Contamination ~3,000 sq miles $100+ billion in costs Accidental Release of Radioactive Materials Tokai-Mura – Criticality Accident Tokai-Mura – Criticality Accident • September 30, 1999, three individuals were exposed to high radiation doses (1700, 800 and 300 rem) respectively (2 subsequently died). • Authorities instructed over 300,000 people to remain indoors (shelter-in-place) for 1 day (within 10 km of the site). • 150 people were evacuated. • 347+ individuals identified as being exposed to levels of radiation above allowed public dose limits (100 mrem) • 20 individuals received radiation doses between (5 and 25 rem) (workers who stopped the chain reaction) One of the three irradiated workers Over the next 10 days 10,000+ individuals sought radiation monitoring Tokai villager is scanned for radiation A total of 76,000 individuals were monitored for surface contamination. 5,700 individuals visited offices for health consultation. Tokai - Demographics • Tokai village – population ~35,000 • Ibaraki Perfecture (county) - ~ 3 million • Near the accident site, 5 major hospitals, 3 secondary hospitals and 1 tertiary hospital. • 788 medical personnel (55 MD, 220 public health nurses, 39 RN, 144 RT, 330 others) were involved in the response at 5 centers. Tokyo Tokai Swedish’s former RSO and Rad Safety Specialist reported that several individuals were provided radiation safety surveys at their request due to concerns of being in Japan at the time of the accident (flight crews and travelers). Fukishima Daiichi March 11, 2011 – April 14, 2011 Chronology • March 11, 2011 – Magnitude 9.0 Earthquake off the coast of the Tohoku Peninsula and subsequent 12 meter high tsunami that hits the northern coast of Honshu • Fukishima Daiichi is a group of 6 boiling water nuclear reactors with a total capacity of over 4,500 MW(e) (roughly the capacity necessary for 350,000 homes in the US) • Only 3 of the 6 plants were operating at the time of the tsunami with a 4th defueled. Chronology • Plants and generators were designed to withstand a 5.7 meter high tsunami (18.7 feet). • The following day battery power on for the reactor cooling system failed resulting the various events that leads to the uncontrolled release of radioactivity into the environment. Effects • Beginning March 15, 2013, measured increases in public exposure in Japan, but not at levels that would lead to any significant change in epidemiology. Public Fears Radiation • Residents flee Tokyo and make a run on supplies US Officials Don’t Understand Radiation Hazards • March 15, 2011 - U.S. Surgeon General Regina Benjamin is in the Bay Area touring a peninsula hospital. NBC Bay Area reporter Damian Trujillo asked her about the run on (KI) tablets and Dr. Benjamin said although she wasn’t aware of people stocking up, she did not think that would be an overreaction. She said it was right to be prepared. 1.3 pCi / m^3 of I-131 detected Would lead to a radiation dose of 1.5 mrem if an individual were to breathe this concentration for 365 days 24 hr/day. Aftermath • Evacuation radius of 20 km, displacing 70,000 residents • About 116,000 individuals were screened for radioactivity with detectable activity found on 102 individuals (limited to clothing in all cases, no intake measurable). • Food and drinking water restrictions were implement for the local area on March 19 and removed on April 2. • Ongoing stigma with regards to foods / products produced in the area. • 17 injuries (15 from explosion/thermal injuries, 2 radiation exposures) Radiological Dispersal Large Scale Release Example Radiological Dispersal Device • Conventional explosive device surrounded by radioactive material. • Passive distribution of radiation from a stationary source or other manual or automated dispersal. • Radioactivity is generally not great enough to be of a significant hazard to personnel. • Used primarily as a device to inspire panic and fear, or in the case of passive dispersal to specifically target an individual or group. • The consensus isotopes that would be used are those commonly used for industrial radiography, medical therapy or sterilization Goiânia, Brazil • 1987: teletherapy head stolen 50.9 TBq (1375 Ci) cesium-137 teletherapy machine left in abandoned clinic Unit dismantled, Cs-137 source capsule ruptured causing major contamination Dose rate at 1 meter from source: 456 rad/hr Goiânia, Brazil • Source stolen on Sept 10. • Initial physiological symptoms (vomiting) on Sept 13. • Initial medical assistance on Sept. 15, diagnosed as an allergic reaction to bad food. • Initial admission to hospital on Sept 23, initial diagnosis tropical disease • Hospital M.D. given portion of radiation source on Sept 28. • Physicist determined source to be radioactive on Sept 29. Goiânia, Brazil • 85 houses significantly contaminated • 200 people evacuated • 7 houses demolished • 12,000+ 55 gallon drums (equivalent volume) of waste disposed. Goiânia, Brazil Exposure of large number of public: • 4 deaths (initially), 5th died in 1994 • Prussian Blue was administered to 46 individuals • 49 received doses from 10 to 620 rad • 249 had some level of radioactive material contamination. • 112,000 were monitored for radioactive material contamination. Goiânia - Demographics • Goiania – population ~1.27 million • 12th largest city in Brazil • Incident involved 3 hospitals in Goiania and 1 in Rio de Janeiro • Radiation monitoring performed at soccer stadium Goiania Rio de Janeiro Radiological Dispersal Small Scale Release Example London, UK • Nov. 1, 2006 – Former Russian Agent is intentionally poisoned with 5 uCi or about 1 microgram of Po-210. • Fell ill within 4 hours and admitted to hospital. • MD suspected poisoning and radioactivity was suggested as a possible cause on Nov. 21. • Individual died on Nov. 23. • On Nov. 24 death officially linked to major dose of radioactivity ingestion. London, UK • 30 locations identified as being potentially contaminated • By Dec. 5, 2006, 3,233 individuals called the British Health Services regarding possible radiation exposure (244 were identified in the group for follow-up) • 238 hospital workers were investigated for possible exposure (71 received further testing) • All initial tests were negative, though an additional 7 individuals were found to have some level of Po-210 contamination on Dec. 7, 2006 (hotel staff). London, UK • In 2007, UK authorities reported that a total of 735 people were tested for Po-210 exposure. • 596 not contaminated. • 120 showed probable contact with Po-210 but at levels indicating no health risks. • 17 showed levels “not significant enough to cause any illness in the short term and any increased risk in the long term is likely to be very small”. Notes Regarding Hospital Response Hospital Radiological Response • No healthcare worker (world wide) has ever received a radiation dose in excess of established radiation dose limits while caring for a contaminated individual. • In General life saving medical care should always take precedence over contamination control. Hospital Radiological Response • Is a nuclear medicine department present. • Is a physicist present (particularly a health physicist). • Are there portable radiation instrumentation available (survey meters). • Does the hospital have an established protocol for emergency response to radiological events. Calling for Help • REAC/TS – Radiation Emergency Assistance Center / Training Site • Located in Oak Ridge, TN • http://orise.orau.gov/reacts/ • 24/7 Availability • 865-576-1005 – ask for REAC/TS • 1-800-NUCLEAR (State of Washington) References • Planning Guidance for a Response to a Nuclear Detonation, Homeland Security Council, Jan. 2009 • Planning Guidance for Protection and Recovery Following Radiological Dispersal Device and Improvised Nuclear Device Incidents, FEMA, DHS, Aug. 2008 • Management of Terrorist Events Involving Radioactive Material, NCRP Report No. 138, Oct. 2001 • NRC Review of the Tokai-Mura Criticality Accident, US Nuclear Regulatory Commission, April 2000 • The Radiological Accident at Goiania, International Atomic Energy Agency, 1988 • Health Effects from Low Level Ionizing Radiation, Biological Effects of Ionization Radiation (BEIR) VII Committee, 2006 • Review of Criticality Accidents, Los Alamos National Laboratory, 2000 • Manual of Protective Action Guides and Protective Actions for Nuclear Incidents, US Environmental Protection Agency, 1992. • Guidance for Radiation Accident Management, Radiation Emergency Assistance Center / Training Site, REAC/TS, Web Document. • Incident of Radioactive Materials Discovered in Scrap Yard Dealer Shops in New Dehli, Government of India, Atomic Energy Regulatory Board Questions?